农村维吾尔族牙周炎与慢性肾功能不全相关性的初步研究
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摘要
目的:研究牙周炎与慢性肾功能不全的相关性。方法:对新疆和田墨玉县所属15个乡进行分层随机抽样调查,抽取3个乡,每个乡有5个村,每个村随机抽取110人,共抽取1650人,其中22人全口无牙不列入本次分析中, 122人未参加口腔检查,其余调查资料完整者1415人纳入本次研究。慢性肾功能不全的诊断标准为GFR<60ml/min/1.73m2。牙周炎的诊断由口腔专科医师完成,依据检查结果将1415名研究对象分为正常组/牙龈炎组、轻度牙周炎组、中度牙周炎组和重度牙周炎组。对调查资料进行卡方检验、多组秩和检验和Spearman等级相关分析。结果:1415人中有935人患牙周炎,占1415人中66.08%;慢性肾功能不全的有19人,占1415人中1.34%。牙周炎组和健康组相比,年龄、性别、血压、血脂、血糖有显著差异。秩和检验结果示:H=18.304,P=0.000。提示四组间差异有显著性意义,可认为不同牙周炎组慢性肾功能不全的患病情况有显著差异,根据平均秩次进一步推断,以重度牙周炎组的差异最为明显,平均秩次=714.55。Spearman相关分析结果:r_S=0.211,P=0。提示牙周炎的严重程度与GFR的下降呈显著正相关关系。结论:牙周炎尤其是重度牙周炎与慢性肾功能不全存在相关性,两种疾病之间相关性的本质仍需进一步明确。
Objective: To study relationship between periodontitis and chronic renal insufficiency. Methods:We conducted a cross-sectional study of 1415 men and women in Moyu county He Tian city. Chronic renal insufficiency is defined as glomerular filtration rate(GFR) less than 60ml/min/1.73m Periodontitis was determined by using an independent clinically derived definition and categorized as health/gingivitis,initial,moder- ateand severe. Chi-square test, and Kruskal-Wallis H test of many groups and Spearman rank correlation analysis models were used to estimate the associations between chronic renal insufficiency and periodontitis. Results: A total of 935(66.08%) individuals had periodontitis. Nineteen(1.34%) individuals had a GFR less than 60ml/min/1.73m.Compar- ed with health/gingivitis, age, sex, blood pressure, blood lipid and blood glucose of periodontitis group were significantly different. Kruskal-Wallis H test showed: H = 18.304, P = 0.000. There was a significant difference among four periodontitis groups. Mean rank(714.55) further showed to severe periodontitis group was the most different. Periodontitis was associated with a GFR less than 60ml/min/1.73m~2(r_S=0.211,P=0). Conclusion: Periodontitis, especially severe periodontitis is associated with chronic renal insufficiency.A prospective study is necessary to determine the exact nature of the observed relationship.
Objective: To study relationship between periodontitis and chronic renal insufficiency. Methods:We conducted a cross-sectional study of 1415 men and women in Moyu county He Tian city. Chronic renal insufficiency is defined as glomerular filtration rate(GFR) less than 60ml/min/1.73m Periodontitis was determined by using an independent clinically derived definition and categorized as health/gingivitis,initial,moder- ateand severe. Chi-square test, and Kruskal-Wallis H test of many groups and Spearman rank correlation analysis models were used to estimate the associations between chronic renal insufficiency and periodontitis. Results: A total of 935(66.08%) individuals had periodontitis. Nineteen(1.34%) individuals had a GFR less than 60ml/min/1.73m.Compar- ed with health/gingivitis, age, sex, blood pressure, blood lipid and blood glucose of periodontitis group were significantly different. Kruskal-Wallis H test showed: H = 18.304, P = 0.000. There was a significant difference among four periodontitis groups. Mean rank(714.55) further showed to severe periodontitis group was the most different. Periodontitis was associated with a GFR less than 60ml/min/1.73m~2(r_S=0.211,P=0). Conclusion: Periodontitis, especially severe periodontitis is associated with chronic renal insufficiency.A prospective study is necessary to determine the exact nature of the observed relationship.
引文
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[23]于晓潜.慢性牙周炎在2型糖尿病发生中作用的初步研究[D ].北京大学口腔医学院, 2006
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[25] Padilla C, Lobos O. Periodontal pathogens in atheromatous plaques isolated from patients with chronic periodontitis [J].J Periodontal Res, 2006, 41 (4):350-353
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[28] Ford PJ. Cross - reactivity of GroEL antibodieswith human heat shock protein 60 and quantification of pathogens in atherosclerosis.[J]. Oral Microbiol Immunol[J]. 2005, 20 (5):296- 302
[29] Choi J I , Chung S W. Epitopemapping of Porphyromonas gingivalis heat shock protein and human heat shock protein in human atheros- clerosis[ J ]. J Dent Res, 2004, 83 (12):936 - 940
[30] Mattila KJ . Dental infections as a risk factor for acute myocardial infarction[J]. Eur Heart J, 1993, 14( Supp l):51-53
[31] Mattila KJ, Pussinen PJ. Dental infections and cardiovascular diseases:a review [J]. J Periodontol, 2005, 76 ( 11 Supp l):2085-2088
[32] Fisher MA, Taylor GW, Shelton BJ , et al .Periodontal disease and other nontradetional risk factors for CKD.[J] Am J Kidney Dis. 2008 ,Jan;51(1):45-52
[33] Thorman R, Neovius M,Hylander B. Clinical findings in oral health during progression of chronic kidney disease to end-stage renal disease in a Swedish population.[J] Scand J Urol Nephrol. 2009;43(2):154-159
[34] Beck JD, Pankow J, Tyroler HA. Dental infections and atherosc- lerosis[J].Am Heart J,1999,138(suppl):528-533
[35] Caps MT, Zierler E, Pollisar NL, et al: Risk of atrophy in kidneys with atherosclerotic renal arterystenosis[J] Kidney Int,1998, 53:735-742
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[37] Mayr M,MetzlerB . Endothelial cytotoxicity mediated by serum antib- odies to heat shock proteins of Escherichiacoli and Chlamydia pneumoniae: immune reactions to heat shock proteins as a possible link between infection and atherosclerosis[J]. Circulation, 1999, 99 (12):1560–1566
[38] Pussinen PJ ,Alfthan G.Severe periodontitis enhances macrophage activation via increased serum lipopolysaccharide[J]. Arterioscler Thromb Vasc B,2004, 24(11):2174– 2180
[39] Herzberg MC.Theplatelet as an inflammatory cell in periodontal disease:interactions with Porphyromonas gingivalis.Molecular pathogennesis operiodontal disease[J].Washington,DC:American Society for Microbiology,1994:247-255
[40] Loescha WJ.Periodontal infection a risk factor for cardiovovascular disease?[J]Postgrad Med, 2000,107:17-20
[41] The American Academy of Periodontology:Position paper.Periodontal disease as a potential risk factor for systemic disease[J]. J Periodontol, 1998,69:841-850
[42] Ross R.Atherosclerosis--An inflammatory disease, N Engl J Med, 1999,340:115-126
[43] Enwonwu CO , Phillips Rs.Nutrition and oral infectious diseases:state of the science[J].The Compendium of Continuing education in Denti- stry ,2002 ,23 (5) :431 - 436
[44] Nishida M , Grossi SG. Calcium and the risk for periodontal diseases [J].Journal of Periodontology ,2000 ,71 ( 7):1057 -1066
[45] Vogel RI,Fink RA.The effect of folic acid on gingival health[J]. Journal of Periodontology ,1976,47 (11) : 667-668
[46] Vogel RI . The effect of topical application of folic acid on gingival health [J].Journal of Oral Medicine ,1978 , 33(1):22-23
[47] Marakoglu I, GursoyUK. Periodontal status of chronic renal failure patients receiving hemodialysis[J].Yonsei Med J,2003,44(4):648-656
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[16] Nishimura F,Iwamoto Y,et al.Periodontal disease and diabetes mellitus:The role of tumornecrosis factor-αin a 2- way relationship [J].J Periodontol,2003,74 (1):97- 102
[17]于晓潜.慢性牙周炎在2型糖尿病发生中作用的初步研究[D ].北京大学口腔医学院, 2006
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[21] Beck JD, Pankow J, Tyroler HA, et al.Dental infections and atherosclerosis[J].Am Heart J,1999,138(suppl):528-533
[22] Caps MT, Zierler E, Pollisar NL, et al: Risk of atrophy in kidneys with atherosclerotic renal arterystenosis[J] Kidney Int,1998,53:735-742
[23] Herzberg MC,MacFarlance GD,liu P,et al.Theplatelet as an inflammatory cell in periodontal disease:interactions with Porphyromonas gingivalis.Molecular pathogenesis of periodontal disease[L].Washington, DC:American Society for Microbiology,1994: 247-255
[24] Mayr M,MetzlerB. Endothelial cytotoxicity mediated by serum antibodies to heat shock proteins of Escherichiacoli and Chlamydia pneumoniae: immune reactions to heat shock proteins as a possible link between infection and atherosclerosis[J]. Circulation, 1999, 99 (12): 1560–1566
[25] Pussinen PJ ,Alfthan G.Severe periodontitis enhances macrophage activation via increased serum lipopolysaccharide[J]. Arterioscler Thromb Vasc B,2004, 24(11):2174– 2180
[26] Herzberg MC. Theplatelet as an inflammatory cell in periodontal disease:interactions with Porphyromonas gingivalis.Molecular pathogennesis operiodontaldisease[J]. Washin-gton,DC:American Society for Microbiology, 1994:247-255
[27] Loescha WJ.Periodontal infection a risk factor for cardiovovascular disease [J]Postgrad Med, 2000,107:17-20
[28] The American Academy of Periodontology:Position paper.Periodontal disease as a potential risk factor for systemic disease[J]. J Periodontol, 1998,69:841-850
[29] Beck JD, Pankow J, Tyroler HA. Dental infections and atherosclerosis[J].Am Heart J, 1999 (suppl),138:528-533
[30] Ross R. Atherosclerosis--An inflammatory disease, N Engl J Med, 1999,340:115-126
[31] Nishida M , Grossi SG . Calcium and the risk for periodontal diseases [J].Journal of Periodontology ,2000 ,71 ( 7):1057 -1066
[32] Vogel RI,Fink RA .The effect of folic acid on gingival health [J].Journal of Periodontology ,1976,47 (11) : 667-668
[33] Marakoglu I, GursoyUK. Periodontal status of chronic renal failure patients receiving hemodialysis[J].Yonsei Med J,2003, 44(4):648-65
[2] AmarS,Gokce N. Periodontal disease is associated with brachial arteryendothelial dysfunction and systemic inflammation[J]. Arterioscler Thromb Vasc Biol 2003,23:1245-1249
[3] Joshipura KJ,Hung HC. Periodonal disease, tooth loss,and incidence of ischemic stroke[J].Stroke,2003,34:47-52
[4] Pussinen PJ,Jousilahti P.Antibodies to periodontal pathogens are associated with coronary heart disease[J].Arterioscler Thromb Vasc Biol,2003,23:1250-1254
[5] Armitage GC , Wu YF . Low prevalence of a periodontitis associated interleukin-1 composite genotype in individuals of Chinese heritage[J]. J Perio dontal ,2000 ,71∶164-171
[6] Lenfant,Clande,Chobanian,et al. Seventh Report Of the Joint National Committee on the Prevention , Detection , Evaluation , and“treatment of High Blood Pressure(JNC7):”Resetting the Hypertension Sails.[J], Hyper- tension 2003,41 (6):1178-1179
[7]中国高血压防治指南修订委员会.中国高血压防治指南[M].北京:人民卫生出版社,2005:3-19
[8]中华心血管病杂志编辑委员会血脂异常防治对策专题组.血脂异常防治建议[J].中华心血管病杂志,1997,25(3):169-175
[9] Guobin X, Lili J, Lihua Z, et al. Application of an improved biuret method to the determination of total protein in urine and cerebrospinal fluid without concentration step by use of Hitachi 7170 auto-analyzer. J Clin Lab Anal,2001,15: 161-164
[10] National Kidney Foundation:K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease:Evaluation,classification,and stratification [J] Part Am J Kidney Dis 2002(suppl 1), 39:S79-S92
[11] National Kidney Foundation:K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease:Evaluation,classification,and stratification[J].Part Am J Kidney Dis 2002(suppl 1), 39:S17-S31
[12] DeStefano F, Anda RF, Kahn HS, et al.Dental disease and risk of coronary heart disease and mortality [J].Br Med J,1993,306:687-688
[13] Abhijit V Kshirsagar ,Kevin L, John R,et al. Periodontal Disease is Associated With Renal Insufficiency in the Atherosclerosis RISKin Cmmunities(ARIC) Study[J].Am J Kidney Disease 2005,45:650-657
[14] Kuroe A, Taniguchi A. Prevalence of periodontal bacterial infection in non-obese Japanese type 2 diabetic patients: relationship with C-reactive protein and albuminuria[J].Horm Metab Res. 2004,36(2): 116-118
[15]许强,张雄.吸烟对牙周炎非手术治疗效果的影响[J].广东牙病防治.2002; 10 (1):222-241
[16]卞金有,胡德渝.口腔预防医学[M].第4版.北京:人民卫生出版社, 2003: 1462-1491
[17] Haber J,Wattles J, CrowleyM.Evidence for cigarette smoking as a major risk fact or for periodontitis[J].J Periodontol, 1993; 64: 16-23
[18] Martine Canut P, Lorca A,Magain R.Smoking and periodontal disease severity[J] J Clin Periodontal, 1995; 22: 743-749
[19] Sznajder R, Carraro JJ, Rugna S, et al . Diabetes and periodontal diseases[J].J Periodontol, 2000, 71 (4):664–677
[20] Katz J,Bhattacharyya I. Expression of the receptor of advanced glycation end products in gingival tissues of type 2 diabetes patients with chronic periodontal disease:a study utilizing immuno- Histo- chemistry and RT- PCR [J].J Clin Periodontol,2005,32(1):40- 44
[21] Iacopino AM. Periodontitis and diabetes interrelation-ship:Role of inflammation [J]. Ann Periodontol,2001,6(1):125- 137
[22] Nishimura F,Iwamoto Y.Periodontal disease and diabetes mellitus:The role of tumornecrosis factor-αin a 2- way relationship [J].J Periodontol,2003,74 (1):97- 102
[23]于晓潜.慢性牙周炎在2型糖尿病发生中作用的初步研究[D ].北京大学口腔医学院, 2006
[24] Mastragelopulos N, HaraszthyV I. Detection of periodontal pathogenic microorganis ms in atheromatous plaque.Preliminary results[J]. Chirurg, 2002, 73 (6):585-591
[25] Padilla C, Lobos O. Periodontal pathogens in atheromatous plaques isolated from patients with chronic periodontitis [J].J Periodontal Res, 2006, 41 (4):350-353
[26] Spahr A, Klein E. Periodontal infections and coronary heart disease: role of periodontal bacteria and importance of total pathogen burden in the Coronary Event and Periodontal Disease (CORODONT) study[J]. Arch InternMed, 2006, 166 (5):554-559
[27] Seinost G, Wimmer G. Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis [J]. Am Heart J, 2005, 149 (6):1050-1054
[28] Ford PJ. Cross - reactivity of GroEL antibodieswith human heat shock protein 60 and quantification of pathogens in atherosclerosis.[J]. Oral Microbiol Immunol[J]. 2005, 20 (5):296- 302
[29] Choi J I , Chung S W. Epitopemapping of Porphyromonas gingivalis heat shock protein and human heat shock protein in human atheros- clerosis[ J ]. J Dent Res, 2004, 83 (12):936 - 940
[30] Mattila KJ . Dental infections as a risk factor for acute myocardial infarction[J]. Eur Heart J, 1993, 14( Supp l):51-53
[31] Mattila KJ, Pussinen PJ. Dental infections and cardiovascular diseases:a review [J]. J Periodontol, 2005, 76 ( 11 Supp l):2085-2088
[32] Fisher MA, Taylor GW, Shelton BJ , et al .Periodontal disease and other nontradetional risk factors for CKD.[J] Am J Kidney Dis. 2008 ,Jan;51(1):45-52
[33] Thorman R, Neovius M,Hylander B. Clinical findings in oral health during progression of chronic kidney disease to end-stage renal disease in a Swedish population.[J] Scand J Urol Nephrol. 2009;43(2):154-159
[34] Beck JD, Pankow J, Tyroler HA. Dental infections and atherosc- lerosis[J].Am Heart J,1999,138(suppl):528-533
[35] Caps MT, Zierler E, Pollisar NL, et al: Risk of atrophy in kidneys with atherosclerotic renal arterystenosis[J] Kidney Int,1998, 53:735-742
[36] Herzberg MC,MacFarlance GD,liu P,et al.Theplatelet as an inflammatory cell in periodontal disease:interactions with Porphyromonas gingivalis.Molecular pathogenesis of periodontal disease[L]. Washin- gton,DC:American Society for Microbiology,1994: 247-255
[37] Mayr M,MetzlerB . Endothelial cytotoxicity mediated by serum antib- odies to heat shock proteins of Escherichiacoli and Chlamydia pneumoniae: immune reactions to heat shock proteins as a possible link between infection and atherosclerosis[J]. Circulation, 1999, 99 (12):1560–1566
[38] Pussinen PJ ,Alfthan G.Severe periodontitis enhances macrophage activation via increased serum lipopolysaccharide[J]. Arterioscler Thromb Vasc B,2004, 24(11):2174– 2180
[39] Herzberg MC.Theplatelet as an inflammatory cell in periodontal disease:interactions with Porphyromonas gingivalis.Molecular pathogennesis operiodontal disease[J].Washington,DC:American Society for Microbiology,1994:247-255
[40] Loescha WJ.Periodontal infection a risk factor for cardiovovascular disease?[J]Postgrad Med, 2000,107:17-20
[41] The American Academy of Periodontology:Position paper.Periodontal disease as a potential risk factor for systemic disease[J]. J Periodontol, 1998,69:841-850
[42] Ross R.Atherosclerosis--An inflammatory disease, N Engl J Med, 1999,340:115-126
[43] Enwonwu CO , Phillips Rs.Nutrition and oral infectious diseases:state of the science[J].The Compendium of Continuing education in Denti- stry ,2002 ,23 (5) :431 - 436
[44] Nishida M , Grossi SG. Calcium and the risk for periodontal diseases [J].Journal of Periodontology ,2000 ,71 ( 7):1057 -1066
[45] Vogel RI,Fink RA.The effect of folic acid on gingival health[J]. Journal of Periodontology ,1976,47 (11) : 667-668
[46] Vogel RI . The effect of topical application of folic acid on gingival health [J].Journal of Oral Medicine ,1978 , 33(1):22-23
[47] Marakoglu I, GursoyUK. Periodontal status of chronic renal failure patients receiving hemodialysis[J].Yonsei Med J,2003,44(4):648-656
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